UK study finds that childhood screening for type 1 diabetes could prevent thousands of emergencies

Results from the first phase of the ELSA (Early Surveillance for Autoimmune Diabetes) study, co-funded by Breakthrough T1D and Diabetes UK, have been published in The Lancet. The findings pave the way for a UK-wide screening programme that could transform how T1D is diagnosed and managed. 

Currently, more than a quarter of children are diagnosed in diabetic ketoacidosis (DKA), a life-threatening emergency requiring urgent hospital care. Early detection through screening can dramatically reduce these emergencies and open access to new treatments that can delay the need for insulin by years. 

What is the ELSA study?

Led by researchers at the University of Birmingham, the study tests blood samples for autoantibodies, which are markers of type 1 diabetes that can appear years before symptoms.   

We know that risk rises sharply with the number of autoantibodies. Children without autoantibodies are unlikely to develop T1D, while those with one autoantibody have a 15% chance of developing the condition within 10 years. Having two or more autoantibodies indicates the immune system has already started attacking the insulin-producing cells in the pancreas and it is almost certain these children will eventually need insulin therapy.   

What the ELSA study found

Among the 17,283 children aged 3-13 years who were screened for type 1 diabetes risk at the time of analysis:  

• 75 had one autoantibody, signaling increased future risk.  

• 160 had two or more autoantibodies but did not yet require insulin therapy, indicating early-stage type 1 diabetes.  

• Seven were found to have undiagnosed type 1 diabetes with all needing to start insulin immediately.   

Families of children found to have early-stage type 1 diabetes received tailored education and ongoing support to prepare for the eventual onset of type 1 diabetes symptoms. This enables insulin therapy to begin promptly when needed, reducing the chances of needing emergency treatment. Children with one autoantibody also received ongoing support and monitoring.  

Some families have also been offered teplizumab, the first ever immunotherapy for type 1 diabetes, which can delay the need for insulin by around three years in people with early-stage T1D. Teplizumab was licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK in August 2025 but is not yet available routinely on the NHS.  

Next Steps: ELSA 2

Building on this strong foundation, the second phase of the research, ELSA 2 launches today. ELSA 2 will expand screening to all children in the UK aged 2-17 years, with a focus on younger children  and older teenagers. The research team aims to recruit 30,000 additional children across these new age groups.  

ELSA 2 will also establish new NHS Early-Stage Type 1 Diabetes Clinics, providing families with clinical and psychological support, creating a clear pathway from screening to diagnosis, monitoring and treatment.  

Amy Norman, 44, from the West Midlands, was diagnosed with type 1 diabetes at the age of 13. She recently discovered via the ELSA study that her 11-year-old daughter, Imogen, is in the early stages of type 1 diabetes but has been able to slow its progression as the second child in the UK to access a breakthrough immunotherapy drug – teplizumab. She said: “Being part of the ELSA study has helped us as a family to prepare for the future in a way we never expected. Knowing what’s coming – rather than being taken by surprise – has made an enormous difference to our confidence and peace of mind. Imogen took part in the study to further research and help others, but it has helped her too – being forewarned is being forearmed. She was always going to develop type 1 diabetes, but through ELSA we’ve been able to slow down the process and prepare – we know what is coming, but we’re not scared.”    

Lead researcher, Parth Narendran, Professor of Diabetes Medicine at the University of Birmingham, said: “We are extremely grateful to all the families who have participated in the study and generously given their time to help understand how a UK-wide screening programme could be developed. Together with Diabetes UK, Breakthrough T1D and the National Institute for Health and Care Research, we are working towards a future where type 1 diabetes can be detected in a timely manner, and families appropriately supported and treated with medicines to delay the need for insulin.”  

Rachel Connor, Director of Research Partnerships at Breakthrough T1D, said: “This is about rewriting the story of type 1 diabetes for thousands of families. Instead of a devastating emergency, we can offer time, choices, and hope. By finding children in the earliest stages, we’re not just preparing families, we’re opening the door to treatments that can delay the need for insulin by years. That extra time means childhoods with fewer injections, fewer hospital visits and more normality. Thanks to research like ELSA, what once struck as an unexpected crisis can become an actively managed healthcare process, changing the course of T1D for the better.”  

For more information about ELSA visit elsadiabetes.nhs.uk.